ABSTRACT
Background: Prescribing antibiotics is a demanding and complex task where decision-making skills are of critical importance to minimize the risk of antimicrobial resistance. Despite its importance, little is known about the decision-making skills and cognitive strategies new Nurse Practitioners (NPs) use when prescribing antibiotics. Objective: To identify the cognitive demands of antibiotic prescribing complexity and to explore the cognitive strategies that new NPs in New Zealand use when prescribing antibiotics. Design: A qualitative approach using Applied Cognitive Task Analysis (ACTA) methodology. Participants: A purposive sample was recruited consisting of five NPs who had been registered within the last five years and were prescribing antibiotics as part of their scope of practice. Methods: In-depth face-to-face interviews consisting of a task diagram interview and a knowledge audit were conducted and analyzed following the ACTA protocol. Results: Four cognitive elements were identified from the data which showed the cognitive demands of prescribing antibiotics, and the cues and strategies NPs use for safe practice. These were: 1 prescribing in the face of uncertainty (complex patients and diagnostic uncertainty); 2 making clinical decisions with insufficient/poor guidance (lack of guidelines, conflicting information); 3 producing an individualized treatment plan in view of clinical and non-clinical patient factors (patient demand/expectation, inadequate patient education, risks versus benefits of antibiotic treatment); 4 ensuring treatment efficacy and continuity of care (ineffective treatment, patient care follow up). Conclusion: The ACTA framework has given insight into the current antibiotic prescribing practice of new NPs, identifying areas where professional development courses and treatment resources can be targeted to support antibiotic prescribing. NPs are likely to benefit from resources that are freely available and reflect national or local antimicrobial data. Further work is also warranted to determine whether targeted education resources and clinical pathways will help with diagnostic uncertainty, and how this could be embedded into existing curricula.
ABSTRACT
The present study examines whether people respond heterogeneously to statewide social distancing mandates as a function of factors that proxy for health risk, economic insecurity, and media consumption. Using longitudinal data of 7400 American adults between March 10 and June 23, 2020, the study examines social-distancing and mask-wearing behaviors. We use a staggered difference-in-difference model to explore whether state policies lead to preventive behaviors. We further examine heterogeneity in individual responses to state mandates by including interaction terms with health risk, economic insecurity, and media consumption. The study finds that state policies lead to increased adoption of these behaviors. Our findings also suggest that old age and living with the elderly are key predictors of preventive behavior adoption in the presence or even absence of state mandates. However, the economically insecure, such as the unemployed, those with low incomes and net worth, or without health insurance, are less likely to adopt preventive behaviors regardless of the mandates. The adoption of the behaviors is also polarized between CNN users and Fox News/Social Media users, with greater compliance by the former.
